Q.
My 12-year-old son was diagnosed with an array of conduct and emotional problems. He has been preoccupied with sex from age 9. I have caught him masturbating the dog and he masturbates a great deal himself. The problem now is that he is becoming more sexual with adult females. He told a lady that he wanted to kiss her. When she refused he became violent and started choking her. He is in an intensive treatment center but no one can give me any answers as to whether he is going to stay this way or what may be causing him to act this way. If a child is hypersexual at age 12, what course of treatment would you recommend?

A.
This sounds like a painful and difficult problem for you, your son, and your family. Of course, without doing a thorough evaluation, I'm not in a position either to furnish a diagnosis or a recommendation for treatment. However, since your son is already in an intensive treatment center, I can suggest some questions and issues to raise with your son's clinical treatment team.

First of all, it is important to rule out any medical or
neurological illnesses that can lead to impulsive, hypersexual, or
aggressive behavior. Although the term conduct disorder is often applied in such cases, this diagnosis sometimes obscures the possibility that other treatable causes for these behaviors exist.

For example, in rare cases, brain lesions or damage in the frontal or temporal lobes can cause episodes of aggressive or hypersexual behavior. (This could be ruled out with brain imaging, such as an MRI, as well as an EEG, which looks at brain electrical
activity). Increased sexual and/or aggressive behavior may also be seen in childhood forms of bipolar (manic-depressive) disorder. In such cases, there are usually "well" intervals, during which the child behaves more or less normally. If your son has not had neuropsychiatric testing (aimed at establishing IQ, learning disabilities, etc.), I would also recommend this.

In the end, if the diagnosis is still not clear, it may be worthwhile considering medications such as anticonvulsant mood stabilizers (e.g., valproate, oxcarbazepine) or lithium. One of the SSRIs (such as Prozac or Zoloft) could also be considered, unless bipolar disorder is present. (Antidepressants can often worsen cycling in bipolar disorder). Sometimes, in cases of co-existing attention deficit hyperactivity disorder (ADHD) and conduct disorder, a psychostimulant (such as Ritalin) may be helpful--but all this depends on a very careful work-up and diagnostic evaluation.

Some form of behavioral therapy is also an important part of treatment for most children with impulse control disorders. Naturally, whether your son stays this way or not depends on the underlying diagnosis. But, with persistence and patience, I am hopeful that effective treatments may be found for your
son.